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Cholesterol guidelines lowered further

WASHINGTON -- New cholesterol guidelines issued yesterday set the lowest level yet for high-risk patients, with recommendations for aggressive use of drugs to get levels down.

The new recommendations also stress that no patient should rely on drugs alone to lower cholesterol, but should also take responsibility for the right diet and exercise to keep the heart and arteries healthy.

Although patients were once told to get so-called bad cholesterol down to about 100, the new guidelines say the highest-risk people need to aim for a low-density lipoprotein level of 70.

''The lower the better for high-risk people," Dr. Scott Grundy, who chaired the National Cholesterol Education Program panel that wrote the guidelines, stated in a release.

The new guidelines, published in the American Heart Association journal Circulation, will be good news for drug companies that make statins and other cholesterol-lowering drugs.

For high-risk people -- who have had a heart attack, diabetes, chest pain, or surgery to clear blocked blood vessels -- the recommendation is to medicate everyone with LDL above 100.

Smokers with heart disease, or patients whose blood pressure is not well controlled, and those considered close to developing diabetes based on blood sugar levels, are also advised to get LDL cholesterol down to 70.

Those considered at moderate risk have multiple risk factors giving them a 10 percent to 20 percent chance of heart attack or cardiac death within 10 years. They are now being told to take drugs if their LDL is 130 or above.

Recommendations for treatment in people at lower or moderate heart risk are unchanged. Grundy, director of the Center for Human Nutrition at the University of Texas Southwestern Medical Center at Dallas, said the drugs should not be prescribed without advice to exercise and eat more fruits, vegetables and fiber and less fat.

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